What is peripheral arterial disease (PAD)?
Peripheral arterial disease (PAD) -- also known as peripheral vascular disease, lower extremity vascular disease, atherosclerosis or hardening of the arteries -- is a disorder that occurs in the arteries of the circulatory system. Arteries are the blood vessels that carry oxygen and nutrient-rich blood from the heart to all areas of the body. Like the blood vessels of the heart (coronary arteries), your peripheral arteries (blood vessels outside your heart) also may develop atherosclerosis -- the build-up of fat and cholesterol deposits, called plaque -- on the inside walls. Over time, the build-up narrows the artery. Eventually the narrowed artery causes less blood to flow to the body’s tissues and a condition called ischemia can occur. A blockage in the legs can lead to leg pain or cramps with activity (claudication), changes in skin color, sores or ulcers and feeling tired in the legs. Total loss of circulation can lead to gangrene and loss of a limb.
What are the symptoms of PAD?
Peripheral arterial disease (PAD) can build up over a lifetime, and the symptoms may not become obvious until later in life. The first noticeable symptom of PAD usually is a painful cramping of the leg muscles when walking. This pain is often noticed in the calf, but may also be felt in the buttocks or thighs. This is a condition called intermittent claudication. The pain can be severe enough to interfere with normal walking. When at rest, the muscles require less blood flow, and the pain goes away. Often, an individual will not feel cramping or pain, but might feel numbness, weakness, heaviness or fatigue in the muscles when walking, and the symptoms are relieved by rest. Many people with early PAD do not have any symptoms.
Other symptoms of advanced PAD may include:
- A burning or aching in the feet and toes while resting, especially at night while lying flat
- Cool skin temperature in the feet
- Color changes in the skin
- Toe and foot sores that do not heal
What are the risk factors for PAD?
An individual is at risk for developing PAD when one or more of these risk factors are present:
- Smoking
- Diabetes
- Older age
- Male gender: PAD affects both men and women, but occurs slightly more often in men
- High blood pressure
- High cholesterol
How is PAD diagnosed?
Your doctor may order certain tests to help diagnose PAD and determine the severity of the disease.
Diagnostic tests may include:
- Ankle/brachial index (ABI). This test compared blood pressure measurements taken in the lower leg with those taken in the arm. Blood pressure cuffs are placed on the arm and leg and inflated, while a hand-held device (called a Doppler) is used to listen to the blood flow in these body areas. The ABI screening helps evaluate the amount of blood flow to the legs and feet, which is decreased in a person with PAD.
- Pulse volume recording (PVR). This test measures the blood volume changes that occur in the legs. During this test, blood pressure cuffs are placed on the arm and leg and inflated slightly while the patient is lying down. Then, the pressure in the cuffs is decreased and the patient is asked to walk on a treadmill for five minutes or until leg pain develops. As blood pulses through the arteries, the blood vessels expand, causing an increase or decrease in the volume of air within the cuff. A recording device displays these pulse volume changes as a waveform on a monitor. Blood pressures can be measured before and after exercise and help define if the pain is due to PAD or other causes.
- Vascular ultrasound. This is a noninvasive test used to examine blood circulation. During a vascular ultrasound, a transducer (small hand-held device) is placed on the skin over the artery to be examined. The transducer emits sound waves that bounce off the artery. These sound waves are recorded, and an image of the vessel is created and displayed on a monitor. This test may be used to detect a blockage in an artery.
Other tests may include angiography, CT scan, or MRA
- Angiography (also called arteriography). These x-rays provide a "road map" of your disease and are routinely used to plan your surgical treatment. Contrast material (dye) is injected into an artery in the groin and X-ray pictures are taken of the inside of the blood vessels being examined to show blood flow and detect possible blockages.
- CT scan. In this diagnostic technique, multiple X-rays are taken from different angles in a very short period of time. The images are collected by a computer and cross-sectional "slices" of the blood vessel are shown on a monitor.
- MRA. This diagnostic aid uses powerful magnets to create images of blood vessels.
How is PAD treated?
Peripheral arterial disease is treated by:
- Lifestyle modification
- Medications
- Nonsurgical interventions
- Surgery
What is lifestyle modification?
Lifestyle modification is recommended to prevent further progression of disease as well as to reduce risk factors for coronary and carotid artery disease. Recommended lifestyle modifications include:
- Quit smoking and using tobacco products.
- Control high blood pressure and diabetes.
- Have regular check-ups with your doctor.
- Have your doctor check your lipid profile and get treatment, if necessary, to reach your lipid goal.
- Eat foods low in saturated fats and cholesterol.
- Achieve and maintain a desirable weight.
- Exercise regularly. Walking is very important and can aid the treatment of peripheral vascular disease.
- Control other stroke risk factors. Limit the amount of alcohol you drink.
What are the medications that can be used to treat lower extremity vascular disease?
Medications may be recommended to reduce fat and cholesterol in your blood and/or to make the blood less "sticky." These include:
- Lipid-lowering "statin" medications.
- An anti-platelet medication (aspirin and/or clopidogrel [Plavix®]) may be recommended. Anti-platelet agents decrease the clotting ability of the blood and are prescribed to reduce the risk of heart attacks and stroke.
- Cilostazol (Pletal®) also may be prescribed. This medication has been shown to improve walking distance in some patients. Your doctor will tell you if this medication may be helpful for you.
What are the procedures that can be used to treat PAD?
There are non surgical and surgical interventions
Nonsurgical interventions
- Balloon angioplasty. Balloon angioplasty opens blocked arteries by pressing plaque against the vessel wall with a balloon inserted with a catheter.
- Atherectomy (laser or mechanical). This procedure removes plaque from arteries using a catheter inserted inside of the artery with blockages.
- Stenting. Stenting involves the insertion of a small metal tube-shaped device into a narrowed artery. The stent serves as a permanent support that keeps the vessel open to permit blood flow.
- Thrombolysis. Thrombolytic therapy uses drugs designed to dissolve clots and restore normal blood flow. The drugs are applied directly to the blockage through a small catheter inside of the artery directed by a guide wire.
Surgical interventions
- Bypass surgery. There are many types of vascular surgical procedures that can be performed depending on the area of occlusion. The bypass graft that best serves your needs will be discussed with you by one of the vascular surgeons after diagnostic testing is completed. A graft, either a vein from your leg or an artificial (man-made) graft, is used to bypass the diseased artery. The graft is used to create a "detour" channel for blood flow around the blocked vessel.
- Amputation -- the removal of part or all of the foot or leg (rarely the arm) for advanced gangrene.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/20/2007…#7151
This information is provided by Cleveland Clinic and is not intended to replace
the medical advice of your doctor or health care provider.
Please consult your health care provider for advice about a specific medical condition.
© Copyright 2012 Cleveland Clinic. All rights reserved.
